<div class="page-header">
    <h1>
        Form TopUp Poin
        <small>
            <i class="icon-double-angle-right"></i>
            TopUp Saldo Poin
        </small>
    </h1>
</div>

<?php
if ($this->errmsg) {
    ?>
    <div class="alert alert-danger">
        <button type="button" class="close" data-dismiss="alert">
            <i class="icon-remove"></i>
        </button>

        <strong>
            <i class="icon-remove"></i>
            Error <br>
        </strong>

        <?php echo $this->errmsg; ?>
        <br />
    </div>
    <?php
}

if ($this->msg) {
    ?>
    <div class="alert alert-info">
        <button type="button" class="close" data-dismiss="alert">
            <i class="icon-remove"></i>
        </button>

        <strong>
            <i class="icon-ok"></i>            
        </strong>

        <?php echo $this->msg; ?>
        <br />
    </div>
    <?php
}

if (!$this->msg && !$this->errmsg) {
    ?>

    <div class="row">
        <div class="col-xs-11">
            <form id="frm" class="form-horizontal" role="form" action="" method="post">
                <div class="form-group">
                    <label class="col-sm-2 control-label no-padding-right" for="acc_num"> Jumlah TopUp </label>

                    <div class="col-sm-9">                        
                        <input type="text" id="jmlTopUp" name="jmlTopUp" placeholder="Cth: 1500000 (Tanpa titik/koma)" value="<?php echo $this->data['jmlTopUp']; ?>" class="col-xs-10 col-sm-5" onkeypress='return validateNumber(event)' required />
                    </div>
                </div>
                <div class="form-group">
                    <label class="col-sm-2 control-label no-padding-right" for="bank_name"> Bank Yang Ditransfer </label>

                    <div class="col-sm-9">
                        <select class="col-xs-10 col-sm-5 chosen-select" id="slBank" name="slBank" data-placeholder="Pilih Suplier..." rquired>
                            <option value=""> Pilih Bank... </option>
                            <option value="BCA: Norek: 28-307-11-841 A/N CUCU SYAMSUL MILLAH Cabang Ujungberung Bandung">BCA: Norek: 28-307-11-841 A/N CUCU SYAMSUL MILLAH Cabang Ujungberung Bandung</option>
                            <option value="BRI: Norek :0750-01-025013-53-0 A/N CUCU SYAMSUL MILLAH Cabang Cibiru Bandung">BRI: Norek :0750-01-025013-53-0 A/N CUCU SYAMSUL MILLAH Cabang Cibiru Bandung</option>
                            <option value="BNI: Norek 002-453-1955 A/N CUCU SYAMSUL MILLAH Cabang Majalengka">BNI: Norek 002-453-1955 A/N CUCU SYAMSUL MILLAH Cabang Majalengka</option>
                            <option value="MANDIRI: Norek 131-00-0726422-1 A/N CUCU SYAMSUL MILLAH Cabang Ujungberung Bandung">MANDIRI: Norek 131-00-0726422-1 A/N CUCU SYAMSUL MILLAH Cabang Ujungberung Bandung</option>
                        </select>  

                        <input type="hidden" name="bank_account_no" value="<?php echo $this->data['acc_num']; ?>" />
                    </div>
                </div>
                <div class="form-group">
                <label class="col-sm-2 control-label no-padding-right" for="tglBayar"> Tanggal Transfer </label>

                <div class="col-sm-3">
                    <div class="input-group">
                    <input class="form-control date-picker" id="tglTransfer" name="tglTransfer" placeholder="Tanggal Transfer" type="text" data-date-format="dd/mm/yyyy" value="<?php echo $this->data['tglBayar']; ?>" required />
                    <span class="input-group-addon">
                            <i class="icon-calendar bigger-110"></i>
                    </span>
                    </div>
                </div>
                </div>

            
            <div class="form-group">
                <label class="col-sm-2 control-label no-padding-right" for="tarik"> Catatan </label>

                <div class="col-sm-4">
                    <textarea id="catatan" name="catatan" class="autosize-transition form-control" placeholder="Catatan"><?php if (isset( $this->data['catatan'] )) { echo $this->data['catatan'];} ?></textarea>
                    
                </div>
            </div>
            

            <div class="clearfix form-actions">
                <div class="col-md-offset-3 col-md-9">
                    <button class="btn btn-info" type="submit">
                        <i class="icon-ok bigger-110"></i>
                        Submit
                    </button>

                    &nbsp; &nbsp; &nbsp;
                    <button class="btn" type="reset">
                        <i class="icon-undo bigger-110"></i>
                        Reset
                    </button>
                </div>
            </div>
        </form>
    </div>
</div>


<script>


    function validateNumber(evt) {

        var charCode = (evt.which) ? evt.which : event.keyCode
        if (charCode > 31 && (charCode < 48 || charCode > 57))
            return false;
        return true;
    }

    


</script>

<?php } ?>